HARM REDUCTION CENTERS ADDRESS A DIFFERENT MODEL OF DRUG USE

Richard struggles to find a vein to inject heroin.

 Photos and Story by Giles Clasen

MOST DAYS IT TAKES RICHARD SEVERAL ATTEMPTS to find a vein.

His veins have scarred from years of heroin use.

“I don’t really like needles,” Richard said. “They’re a

necessary evil.”

Richard ended up living on the streets within weeks of

graduating high school. His mom kicked him out. They didn’t

get along.

She was a hard-working single mom who worked as a nurse

in Salt Lake City. Richard was aimless, struggled in school,

and started smoking pot at a young age. He believes that his

mom hoped kicking him out would force him to grow up.

Instead, it took away the little stability in his life.

“I was also picked on a lot when I was younger,” Richard said.

“My high school days were hellish for me. And then on top

of that, when I got kicked out and was living on the streets, I

couldn’t call anybody, I couldn’t rely on anybody.”

Richard bounced from couch to couch. He tried to work

the kind of jobs 18-year-olds work. But it was very difficult

to make it to work each morning when he wasn’t sure where

he would sleep at night. Eventually, Richard gave up trying to

work, moved to California, and traveled from town to town.

Richard smoked pot to take the edge off of his chaotic life.

He would take acid or mushrooms when he could find them.

Within a few months of living on the street, he tried meth at

a party. Later a friend injected him with a goofball, a mix of

meth and heroin.

The steps seemed small; pot to psychedelics to meth, to

heroin. Now he spends $80-$90 a day on heroin to get by.

“I hate chasing all the time,” Richard said. “It’s all I do. I

chase, I chase, I chase. I hate going to bed at night because if

I don’t have anything, I know I’m going to wake up sick. Now,

if I go to bed with a little bit of money and some dope, I sleep

like a baby because I’m good in the morning. These drugs,

man, they tie you down, they take your soul in a sense.”

Lisa Raville said she thinks the discussion about drug

use needs to change. Raville is the executive director of the

Harm Reduction Action Center, a nonprofit providing clean

syringes to intravenous drug users along with other services,

and she believes the old model of addiction and treatment

needs to change.

“We don’t talk about addiction here, we talk about chaotic

drug use and non-chaotic, problematic and non-problematic,”

Raville said. “If you have money, you can keep up drug use

for a long time. Rock stars do it all the time. It’s when you’re

unhoused, in and an out of incarceration, in withdrawal, not

eating well, that’s when it can really take a physical toll on

your body.”

Think of non-chaotic drug use as having a prescription

filled for an opioid pain killer. Non-chaotic use means the

drug is taken as prescribed without mixing it with other

drugs to amplify the effect. The patient will continue all of

their regular responsibilities to their job and family while

taking the prescription. The drugs are present but not

destroying a life.

Chaotic drug use is the chase for a high that leads to

damaging behavior. It often involves mixing multiple drugs

which can lead to drug poisonings or overdoses. Chaotic drug

use can also cause homelessness, broken relationships, and

many of the darker images we associate with drug abuse.

A newer model of drug use suggests an individual can move

from chaotic use to non-chaotic drug use, even when using

illegal drugs. Abstinence may not be the only way to health,

though sobriety may still be the individual’s goal.

The old ideas of drug use can box individuals in, Raville

said. It creates a stigma. The idea that one who uses drugs is

morally bad impacts all the interactions drug users have with

the world.

“If stigma, shame, and incarceration worked with drug

use, we’d have wrapped this up years ago,” Raville said. “All

it’s done is drive this underground, where people have gotten

preventable chronic diseases such as HIV, Hepatitis C, and

have died of overdose.”

Richard was diagnosed with Hepatitis C a few years ago

from sharing syringes. So far, he hasn’t had any major health

crisis related to the diagnosis, but he fears it will impact his

life and health over time.

Stigma forces drug users away from relationships with

friends and family. Stigma pushes drug users away from treatment and the medical profession that is supposed to

help them. Stigma around drug use isolates.

Brittany Pettersen believes isolation is addiction’s best

friend. The Jeffco Senator grew up with a mother who used

heroin. Pettersen has been a strong advocate at the Colorado

State Capitol for increased services and care for individuals

confronting drug dependence.

“Why a place like the Harm Reduction Action Center is so

important is that it starts building the human connections

again,” Pettersen said. “When you think about being

homeless, and you’ve literally lost everything, most people

are not connected to family anymore. They’ve been failed by

our system.”

The Harm Reduction Action Center is trying to step

in and begin building the relationships needed to help

individuals move from chaotic drug use to stable drug

use and maybe sobriety. Often, the steps to sobriety begin

with kindness. That is why every person who walks into

the Harm Reduction Action Center is greeted by someone

saying, “I am happy to see you.”

It is a small kindness, but that kindness and those services

help individuals feel comfortable coming back. Each return

means a drug user may reach out for more services.

“They don’t have to come here,” Raville said. “We want to

be as relevant as the community in which we serve, so we

try to be a one-stop-shop. The next few times they come in,

they go, ‘I heard you can get your mail here.’ I say, ‘Absolutely,

here’s how that works.’ Or, [they say] ‘I think I need to get my

Medicaid going,’ to which we say, ‘Great, that sounds good.’

Maybe [they will say], ‘I think I want to get into treatment,’

and we tell them, ‘Great, let’s sit down and talk about that.’”

The good news is that starting in January 2021, Colorado

will be expanding in-patient treatment for Medicaid

recipients who struggle with substance abuse, part of a bill

Pettersen sponsored.

Still, Pettersen isn’t satisfied. She knows Colorado can save

money and lives by further increasing access to substance

abuse services.

Richard doesn’t know if he is ready for treatment yet.

“I’ve been in multiple programs, and, yeah, they help for

a minute,” Richard said. “But you can ask any addict, you

get bored sometimes, or you get those really intense urges,

and sometimes, it’s more than you can handle, and you end

up slipping.”

He isn’t sure how he would fit into the “normal” world

after living on the streets for 15 years. He would like an

apartment and isn’t sure he would sleep in it every night. He

may find himself coming back to his tent in an alley from

time to time because he is comfortable there, accepted by

the street community.

“This is all I know,” Richard said. “I know how to survive

like this. I don’t know how to survive having a 9 to 5. When

it comes to managing money, I don’t know nothing about it.

I don’t like to say I’m envious. But sometimes I look at these

people driving their cars and going to the mall. And I’m like,

man, you know that would be nice.” ■